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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 1  |  Page : 36-39

Knowledge and practice of endodontic treatment carried out by general practitioners in Chennai: A questionnaire survey


Department of Conservative and Endodontics, Best Dental College, Tamil Nadu, India

Date of Submission06-Oct-2021
Date of Acceptance20-Oct-2021
Date of Web Publication29-Nov-2021

Correspondence Address:
Dr. Shakul Hameed
Senior Lecturer, Department of Conservative and Endodontics, Best Dental College, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijosr.ijosr_7_21

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  Abstract 


Introduction: Root canal treatment (RCT) is taken into account as a necessary component within the dental services provided to the population in developed furthermore as developing countries. It is the responsibility of the academics and dental schools to prepare their students to adopt the guidelines and recommended standards in root canal debridement, shaping, and obturation. The aim of this questionnaire survey was to evaluate the knowledge and practice of endodontic treatment carried out by general practitioners in Chennai. Materials and Methods: A questionnaire was developed with 15 questions based on knowledge and practice of endodontic treatment and was sent to 50 general dental practitioners (n = 50). The collected data were entered into a personal computer and analyzed. Results: In the present study, all the participants, i.e. 100%, reported that they perform root canal procedures in posterior teeth. Isolation was mainly done using rubber dam in 32% of the dentists. The step-back technique was the most popular root canal preparation technique (76%). Forty-two percent of the dentists in Chennai tended to use hand instruments and 40% of them prefer K-files for cleaning and shaping the root canals. Every dentist in Chennai takes radiographs in every step of RCT. Fifty-eight percent of the dentists used normal saline for irrigation. Every dentist reported that they use gutta-percha as an obturating material in which 52% of them used lateral condensation technique. Every dentist used zinc oxide eugenol as a sealer. The coronal access cavity was sealed by temporary restorative material immediately after the treatment, and the permanent sealing was done later on by themselves. Conclusion: Based on this survey, it was demonstrated that dentists performed procedures which often deviated from well-acknowledged endodontic quality guidelines. General practitioners did not seem to keep up with recently introduced techniques but use more conventional methods. Most of the conventional techniques used by dentists were reported to have increased success rate.

Keywords: Endodontic treatment, filling material, instruments, irrigants, isolation, obturation


How to cite this article:
Saravanan K, Hameed S. Knowledge and practice of endodontic treatment carried out by general practitioners in Chennai: A questionnaire survey. Int J Soc Rehabil 2021;6:36-9

How to cite this URL:
Saravanan K, Hameed S. Knowledge and practice of endodontic treatment carried out by general practitioners in Chennai: A questionnaire survey. Int J Soc Rehabil [serial online] 2021 [cited 2022 Jun 28];6:36-9. Available from: https://www.ijsocialrehab.com/text.asp?2021/6/1/36/331482




  Introduction Top


Endodontic treatment is an essential part of comprehensive quality dental care. Root canal treatment (RCT) is defined as the combination of mechanical instrumentation of root canal system, its chemical debridement, and filling with an inert material, designed to maintain or restore the health of the periradicular tissues. The manner of execution of treatment procedures is so diverse even within prescribed protocols that it is difficult to define it any more precisely and it is accepted that this treatment intervention is not by its nature standardizable.[1],[2]

The goal of endodontic and restorative therapy is to restore the normal function and occlusion of the tooth and to maintain the stability of the dental arch. The strength of the endodontically treated teeth is directly connected to the bulk of the remaining dentin. Root-filled teeth with intact coronal structure have a good long-term prognosis.[2],[3] Several studies have revealed that the majority of dentists do not comply with the formulated guidelines on the quality of RCT.[4],[5],[6],[7] It is the responsibility of the academics and dental schools to prepare their students to adopt the guidelines and recommended standards in root canal debridement, shaping, and obturation.[1],[3] The rationale of this study was to evaluate the practice and knowledge about RCT of molar teeth by private general dental practitioners in Chennai. The purpose of the questionnaire was not only to collect baseline data but also to determine the endodontic knowledge and practice of dentists. Furthermore, it was hoped to gain an insight into potential problems regarding endodontic treatment procedures that could explain the present standard of RCT carried out by general dental practitioners. The aim of this cross-sectional survey was to evaluate the knowledge and practice of endodontic treatment carried out by general practitioners in Chennai.


  Materials and Methods Top


A survey on general dental practitioners in Chennai was carried out to investigate common materials and methods employed in RCT. A questionnaire was developed with 15 questions based on knowledge and practice about endodontic treatment and was sent to 50 general dental practitioners (n = 50). The collected data were entered into a personal computer and analyzed. The questionnaire consisted of questions concerning different aspects of endodontic treatment including the provision of root canal therapy stages, materials, the choice of instruments, isolation methods, radiographs taken throughout the treatment, the use of canal irrigants and intracanal medicaments, the choice of obturation technique, temporary and permanent coronal restoration, and case monitoring and follow-up. The collected data were entered into a personal computer and analyzed.


  Results Top


Based on the questionnaire survey, it is found that all 50 practitioners performed RCT by themselves including molar RCT (100%). The practitioners did not use rubber dam for all the treatments. Considering the frequency of usage, 90% of the dentists reported occasional usage of rubber dam (90%) [Table 1]. Almost everyone preferred to take radiograph in every step of the treatment. Gutta-percha (100%) was the only material used by every dentist in Chennai to obturate with zinc oxide eugenol (100%) as a sealer. The coronal access cavity was sealed by temporary restorative material immediately after the treatment, and the permanent sealing was done later on by themselves.
Table 1: Choice of isolation method

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  Discussion Top


The reason for this study was to gather both qualitative and quantitative information on endodontic treatment by dentists working in Chennai and to analyze the advantages and disadvantages of each. In the present study, all the participants, i.e., 100%, reported that they perform root canal procedures in posterior teeth. The use of rubber dam is always recommended during RCT to provide isolation and protection and improve visibility, 32% of dentists reported using rubber dam occasionally, while 30% of dentists use cotton rolls for isolation.[8] However, 59% of the American dentists,[9] 60% of the dentists in the UK, and 57% of the dental practitioners in New Zealand[10],[11] reported using rubber dam during every endodontic procedure. The reasons for not using rubber dam could be the extra cost, additional time, lack of adequate skills or training, absence of patient's acceptability, or inadequate education in the undergraduate teaching curriculum.[12]

The step-back technique was the most popular canal preparation technique among general dental practitioners for about 76% [Table 2]. The filing (push-pull) technique, on the other hand, was used by only 6% of the dentists. Whereas, 18% of the dentists use step-down technique [Table 3]. In general, dentists in Chennai intended to use hand instruments 42% and 16% of dentists use engine-driven techniques for shaping the root canal system, while 42% of dentists reported using both. Most of the dentists who prefer K-files are used for shaping the canals (40%), 20% of the dentists use reamers and K-files, and very few doctors use H-files (2%). Thirty-eight percent of the dentists use all three instruments for better quality of treatment [Table 4]. Every dentist in Chennai takes radiographs in every step of RCT. In the current survey, most of the general dental practitioners used normal saline (58%) as a root canal irrigant, 20% of the dentists in Chennai used chlorhexidine as an intracanal irrigant, while 14% used sodium hypochlorite [Table 5]. The material of choice for irrigating the root canal system was sodium hypochlorite because of its effective antimicrobial and tissue-solving action. However, using sodium hypochlorite or hydrogen peroxide without isolating the field of operation with a rubber dam presents a hazardous practice [Table 6]. A similar trend of using sodium hypochlorite as a root canal irrigant without using rubber dam for isolation, was noticed among Flemish dentists.[6] A very few practitioners use hydrogen peroxide as an irrigant in endodontic treatment [Table 7].
Table 2: Choice of cleaning and shaping technique

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Table 3: Type of instrument

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Table 4: Preference of hand instruments

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Table 5: Choice of irrigants

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Table 6: Preference of obturation technique

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Table 7: Preference of temporary restorative material

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Absolutely, every dentist in Chennai uses gutta-percha points as an obturation material in endodontic treatment. Fifty-two percent of the dentists used lateral condensation technique for obturation which had increased success rate, where 48% used a single-cone technique which is easier and less time consuming. Cold lateral condensation of gutta-percha in conjunction with a root canal sealer is the most widely accepted technique for obturating root canals.[13] It is a relatively simple and versatile technique that does not require expensive equipment. It is therefore not surprising that it is the technique used by the majority of responding practitioners (especially the younger ones) in their general practice. Single-cone/point techniques cannot reliably fill all the root canal spaces in three dimensions and are not recommended, although this technique was practiced once upon a time. Similarly, paste-only root fillings are difficult to control with the obvious risk of under- or overfilling of the canal. This is particularly problematic with paraformaldehyde-based sealers, as they can cause extensive damage to the periradicular tissues.[14],[15],[16] The trend is toward the use of warm gutta-percha techniques to improve the filling of accessory anatomy such as fins and apical deltas.[17] However, 31.3% of the dentists in Jordan used a single-cone technique, in common with 68% of the Swiss dentists.[18] The temporary filling material after endodontic treatment used in most common is zinc oxide eugenol by 54% of the doctors, and 46% use intermediate restorative material as temporary filling material.

Based on this study, the number of practitioners using inappropriate techniques/materials was quite small, and there are possibilities of changing behavior with education to bring successful results.[19],[20],[21],[22],[23] This study sheds light on current preferences for various endodontic materials and techniques. It also notes the potential possibility for educational interventions.


  Conclusion Top


Within the limitations of this study, it was demonstrated that dentists performed procedures which occasionally deviated from well-acknowledged endodontic quality guidelines. General practitioners seem to use more conventional methods. It is recommended and vital to impart a higher level of continuing dental education for general practitioners to update their knowledge in the field of endodontics.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Outcome of primary root canal treatment: Systematic review of the literature – Part 2. Influence of clinical factors. Int Endod J 2008;41:6-31.  Back to cited text no. 1
    
2.
Al-Fouzan KS. A survey of root canal treatment of molar teeth by general dental practitioners in private practice in Saudi Arabia. Saudi Dent J 2010;22:113-7.  Back to cited text no. 2
    
3.
Akbar I. Knowledge, attitudes and practice of restoring endodontically treated teeth by dentists in north of Saudi Arabia. Int J Health Sci (Qassim) 2015;9:41-9.  Back to cited text no. 3
    
4.
Gatewood RS, Himel VT, Dorn SO. Treatment of the endodontic emergency: A decade later. J Endod 1990;16:284-91.  Back to cited text no. 4
    
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Al-Omari WM. Survey of attitudes, materials and methods employed in endodontic treatment by general dental practitioners in North Jordan. BMC Oral Health 2004;4:1.  Back to cited text no. 5
    
6.
Weiger R, Hitzler S, Hermle G, Löst C. Periapical status, quality of root canal fillings and estimated endodontic treatment needs in an urban German population. Endod Dent Traumatol 1997;13:69-74.  Back to cited text no. 6
    
7.
Jenkins SM, Hayes SJ, Dummer PM. A study of endodontic treatment carried out in dental practice within the UK. Int Endod J 2001;34:16-22.  Back to cited text no. 7
    
8.
Slaus G, Bottenberg P. A survey of endodontic practice amongst Flemish dentists. Int Endod J 2002;35:759-67.  Back to cited text no. 8
    
9.
Hommez GM, Braem M, De Moor RJ. Root canal treatment performed by Flemish dentists. Part 1. Cleaning and shaping. Int Endod J 2003;36:166-73.  Back to cited text no. 9
    
10.
Whitten BH, Gardiner DL, Jeansonne BG, Lemon RR. Current trends in endodontic treatment: Report of a national survey. J Am Dent Assoc 1996;127:1333-41.  Back to cited text no. 10
    
11.
Koshy S, Chandler NP. Use of rubber dam and its association with other endodontic procedures in New Zealand. N Z Dent J 2002;98:12-6.  Back to cited text no. 11
    
12.
Ahmed HM, Cohen S, Lévy G, Steier L, Bukiet F. Rubber dam application in endodontic practice: An update on critical educational and ethical dilemmas. Aust Dent J 2014;59:457-63.  Back to cited text no. 12
    
13.
Geetha RV, Veeraraghavan VP. Evaluation of antibacterial activity of five root canal sealants against Enterococcus faecalis – An in vitro study. Int J Pharm Sci Rev Res 2016;40:221-3.  Back to cited text no. 13
    
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Kaufman AY, Rosenberg L. Paresthesia caused by endomethasone. J Endod 1980;6:529-31.  Back to cited text no. 14
    
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Marshall K, Page J. The use of rubber dam in the UK. A survey. Br Dent J 1990;169:286-91.  Back to cited text no. 15
    
16.
Erişen R, Yücel T, Küçükay S. Endomethasone root canal filling material in the mandibular canal. A case report. Oral Surg Oral Med Oral Pathol 1989;68:343-5.  Back to cited text no. 16
    
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Priyanka SR. A literature review of root-end filling materials. J Dent Med Sci 2013;9:20-5.  Back to cited text no. 17
    
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Barbakow F. The status of root canal therapy in Switzerland in 1993. J Dent Assoc S Afr 1996;51:819-22.  Back to cited text no. 18
    
19.
Lawson NC, Gilbert GH, Funkhouser E, Eleazer PD, Benjamin PL, Worley DC, et al. General dentists' use of isolation techniques during root canal treatment: From the National Dental Practice-based Research Network. J Endod 2015;41:1219-25.  Back to cited text no. 19
    
20.
American Dental Association. Bureau of Economic Research, American Dental Association. Survey Center. Survey of Dental Practice. American Dental Association, Bureau of Economic Research and Statistics; 1965.  Back to cited text no. 20
    
21.
Koch M, Eriksson HG, Axelsson S, Tegelberg A. Effect of educational intervention on adoption of new endodontic technology by general dental practitioners: A questionnaire survey. Int Endod J 2009;42:313-21.  Back to cited text no. 21
    
22.
Gound TG, Sather JP, Kong TS, Makkawy HA, Marx DB. Graduating dental students' ability to produce quality root canal fillings using single- or multiple-cone obturation techniques. J Dent Educ 2009;73:696-705.  Back to cited text no. 22
    
23.
Hale R, Gatti R, Glickman GN, Opperman LA. Comparative analysis of carrier-based obturation and lateral compaction: A retrospective clinical outcomes study. Int J Dent 2012;2012:954675.  Back to cited text no. 23
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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